HUMAN ANATOMY KNEE :Fibromyalgia is not a new condition. Fibromyalgia has been around as long as there have been animals and humans. It can affect any person on the planet and is associated with many "Injury Factors" .The complete condition is more common in women, but it is also common in men, and I have seen it even in children and young people.
Is There A Cure For Fibromyalgia?
At a basic level, most people with fibromyalgia are suffering from diffuse muscle and tendon shortening, driven in part by multiple nerve compressions throughout the spine and limbs. Spinal origins from the neck, mid back and low back figure prominently in it's source of pain. It seems deep spinal muscles cause deep nerve compressions and traction that cause further muscle problems in the spine, limbs and head. Pain can be directly from the muscles crushing a joint, or from pain referring into the joint from the spine. Typically both exist at the same time. Headaches can exist from referred pain from the neck but also from local muscle problems around the head.
Fibromyalgia is very much a chicken and egg story. Which came first- the muscle problems or the nerve problems. The answer, for most is that the disease originates from paraspinal muscle problems. To better understand the condition, we must learn some biophysics.
One of the most important principles that must be understood is that, once adulthood is reached, adult skeletal muscles shorten with exercise, injury or any movement of the muscle. This is probably related, in part, to a decrease in growth hormone levels as we move into adulthood. It appears that growth hormone has an affect upon the degree in which muscles sustain exercise and injury.
In general, the more like a child we are, the better. This is why a child can run all day and not tire out or ache and then wake the next day and run all day yet again. This is also why most adults over thirty have difficulty running a block or two without hobbling to their car. Fortunately ,there are some people who run into their thirties and beyond. In fact, one of my patients is over sixty-five and has run as much as two marathons within a few days!
This ability is possible for several reasons. One is that most have become accomplished stretchers and can overcome the first principle. Also they probably have well-aligned biomechanics for running and likely have good running technique. Nevertheless, many of the over-thirty crowd will eventually succumb to knee pain from running .
Another important principle is that muscles that are injured during work , shorten from those injuries during rest, such as during sleep, sitting or standing. This will cause joint compression of the spine and limbs and causes crepitus, or cracking of the joint, joint stiffness, joint pain, and eventually osteoarthritis of the joint. Much of this shortening is gradual ,over months or years, but it does happen. This is why we are stiff when we wake, or after sitting or standing for a period of time. Anything that aggravates your sleep will also make the muscle shortening worse.
These very important points are part of the fibromyalgia devil's triangle that I describe. The triangle being - severe pain which causes sleep problems - which causes anxiety - which causes more muscle pain - which causes more sleep problems - which causes more anxiety and around and around it goes.
Chronic pain will disrupt normal sleep cycles by acting as a "stimulant" to your sleeping ability. Medications, supplements and treatments that block this affect will help fibromyalgia significantly.
The Fibromyalgia Triangle
Chronic Pain - Sleep Disruption - Anxiety/Depression
Walter Cannon demonstrated in the 1940's that any animal tissue that becomes denervated would become supersensitive. In other words, pinch a nerve, and all tissues supplied by that nerve would become very irritable and electrically sensitive. This actually makes sense because the tissue has lost direction from its nerve.
Not all tissue is affected in a bad way but muscle tissue responds by becoming tighter or more spastic. This kind of spasm does not go away until the nerve function is restored. This is why a person with a pinched low back nerve has trouble with hamstring lengthening and cannot bend over. There are many more possible examples but remember that a pinched nerve will cause persistent muscle spasm and other tissue abnormalities.
Another important principle is that muscles that remain persistently spastic or short will eventually scar into a tight spastic position causing abnormal joint movement and compression. This will lead to disk compression and herniation, arthritis and subluxations of the spine. It will also cause joint compression in the limbs and abnormal tracking ,which will cause abnormal wear points and osteoarthritis.
This is why I have renamed osteoarthritis compression arthritis, as it is a more accurate description of the cause of the arthritis.
To understand further, the spine is lined with five layers of muscles. The three top layers are designed to be the heavy work muscles for the spine and the two deepest layers are designed to be the structural integrity for the spine. These deep muscles, primarily the multifidus and the rotator brevis and longus muscles are probably the most important muscles of the body.
These muscles allow our spines to move without falling apart. They are very strong but also very small. They are not designed for heavy work but unfortunately will be exposed to work and injury over time. These muscles become very tight and scarred and can literally crush segments of your spine. They can be released but only with very hi-tech needling techniques, or very hi-tech exercise therapy. These muscles will be the primary cause of most spinal disease.
I should introduce the term neuropathy and myofascial pain at this point. Neuropathy is a term to describe nerve disease or injury. This includes diseases such as multiple sclerosis, but also includes myofascial compression/traction neuropathy, or "pinched nerves". The most common neuropathy, or nerve "disease" is definitely a pinched nerve because virtually all adults and most adolescents will have some degree of compression neuropathy at the base of their neck and low back. The deep spinal muscles cause directly, or indirectly, most of the pinched nerves we experience in our lives.
The term myofascial pain or MFP for short is a term to describe muscle and tendon pain. "Myo" refers to muscle, and "fascia" refers to the connective tissue of muscle and tendon. Together they refer to a group of conditions caused by muscle dysfunction that lead to various patterns of acute or chronic pain. Myofascial dysfunction or MFD is similar, but refers to the abnormal function of muscle due to neuropathy and myofascial pain.
From a biophysical point of view, the base of the neck and low back are the weak links of the spine. The base of the neck and low back are most susceptible to muscle injury and scarring. The areas of note are between the fifth cervical, or neck vertebrae and the seventh cervical vertebrae. In the low back, the weak areas are between the fourth lumbar vertebrae and the first sacral vertebrae.
Although these areas are the most susceptible by design, I will remind the readers that I have found severe abnormalities virtually at all levels of the spine and, in the case of fibromyalgia, this is generally so.
Injury factors are simply the factors related to a person's pain problem. Even though many will deny any obvious injury, I will assure that person, injuries have occurred. A quick list of injury factors include:
Increased Age Repetitive Work Types and Severity of Accidents Joint deformity Hormonal Effects (Growth Hormone, rapid cycling of periods, low estrogens and progestins, low testosterone) The Presence of Stress or Worry Inherent Anxiety Level Types of Work and Workload The Absence of Stretching Muscle Bulk and Strength Muscle Length Nerve function Inherent flexibility of muscle Types of Hobbies and Past-times Drug Effects upon muscles
There are an infinite number of Injury Factors related to MFP and MFD. The ones that I have listed are really the common ones that I see everyday. The importance in understanding the idea of an injury factor, is that it helps the individual attempt to identify which factors might be important in their pain disorder.
Not every one has the same factors at the same level of importance. The identification of a person's individual factors is very important for both recovery and maintenance of health. For instance, anxiety and depression can contribute to increased intrinsic muscle tone, especially in the upper back and neck. Stress reduction techniques will help those individuals with "stress" acting as a major factor for their condition. Hormones, or the lack thereof, may play a role in the gradual onset of MFP for most adults with chronic pain over 50. Supplementation may play a role in their recovery but probably not a singular major role.
Sharing my understanding of the importance and benefits of muscle length and stretching is a personal crusade for me. The health of a nerve can determine the health and function of its affiliated muscle groups.
Medications can have a negative and positive effect. As example, some of the cholesterol lowering medications can cause an increase in muscle spasm and shortening all over our bodies causing increased joint pain and compression. Other medications, such as anti-inflammatories, can make a dramatic change in our muscles ability to combat or recover from injury. The work we do has a large impact on the pain problems we will develop.
As a general rule, the muscle groups most used will be the groups most affected. (e.g. Letter carriers will tend to suffer torsion of their spine from carrying the postal bag and repetitive strain of their dominant arm due to sorting.)
Contrary to what might be expected by most, athletes suffer more severely than the average person does because they traumatize their muscles and joints more than the average person. However, this not need be the case, most athletes are not receiving the proper preventative care for arthritis.
One of my most important points that I am often quote is ...
"Given that a person lives long enough, we all will develop fibromyalgia. The best you can hope for is to keep it at bay."
The cause of most, if not all, fibromyalgics pain is a combination of nerve and muscle dysfunction. The deep spinal muscles cause minor or even major nerve entrapment syndromes. Those nerve injuries will cause pain that refers into our limbs, head and body. They can create dizziness, ringing of the ears ,abdominal pain and bloating. Palpitations may be created by sympathetic exaggeration .Visual blurring may originate from neck problems.
The weakest segments of the spine are the base of the neck and back but the middle of the back is also commonly affected.
Fatigue occurs for several reasons ,commonly because of a protracted disruption of sleep due to stimulation from the chronic pain. Muscles will tighten up when a nerve is pinched, as Walter Cannon proved in the 1940's. Injury factors will determine the age of onset, the severity, and the pains associated with the condition.
A comprehensive stretching program will prove to be the single determining factor for prevention. Career, lifestyle, depression and age are also important.
Good news! Although it seems like this condition is incurable, this is not so. Fibromyalgia is potentially reversible! I have demonstrated this with thousands of my patients and myself.
An example of recovery:
First a plan of attack is helpful. This is war and the stakes are high. Understanding your condition is extremely important- become comfortable with the main aspects and anatomy of the condition.
No Fear. Do not be afraid of fibromyalgia. At first the severity of pain is very scary and frustrating. However, it is very important that calmness prevails because anxiety will only make the pain and your sleep patterns worse. People do not usually die of fibromyalgia, they often only wish they did.
Learn as much as you can about stretching, physiotherapy and chiropractic.
Prevent injury. An ounce of prevention is worth a ton of cure. If you are suffering from a chronic pain syndrome, do not test the limits of the condition by over-exercising or doing tasks that you know are going to cause you more pain later. Pace yourself and attempt to reduce injury and pain. Do however, try to avoid being a couch potato.
Begin with a good, comprehensive stretching program like my Stretching Videos http://www.stretch-doctor.com Always use stretching programs in consultation with a therapist because if you "race through stretching with all guns ablazing", you are bound to get hurt. GO-SLOW is the rule of the game.
Research physiotherapy in your area and find out who is respected. Some one who has the time and patience to help a fibromyalgic is very important. Within the area of physio there are numerous tools such as "cold laser", traditional ultrasound, and a new powerful focused ultrasound that can break muscle scarring. Manipulation, stretching and traction can be helpful but are often a little too painful for the fibromyalgic in the early stages of therapy.
Chiropractic can be very effective for many people. The theories of spinal and joint relocation are basically proven. Chiropractic can be effective but it has downsides. Some of the manipulations can be too painful to endure early on in the recovery but may be more effective as the recovery proceeds.
Injection Therapy is a huge area. There are as many ways to perform this, as there are needle therapists. I myself, have developed various techniques that I call upon to break the spinal and limb muscle spasm and scars. One of my techniques is a modified version of Intramuscular Stimulation, or IMS. My mentor Dr. Chann Gunn of Vancouver, B.C, invented IMS. I have made a few modifications to "tweak it a bit." It is very important to break loose virtually all the scars in the muscle of the neck, mid-back and low back. You must then proceed to treat the limbs in their entirety. The problem with this technique is that it involves literally two to three hundred needle injections, most of which are quite painful. However, there are techniques to overcome the pain of the treatment. Paraspinal nerve blockade can diminish the pain, as well as pre-medication with analgesics like codeine and oxycodone.
Some benefit can be achieved with Botox, and, in fact, I am one of the first reported, if not the first, to treat the deepest spinal layers with Botox injection in North America. I would, however, not begin with this drastic technique, as I do not believe Botox to be the solution for fibromyalgia. Due to the extent of the muscle problem, I believe that most fibromyalgics will require some form of needle therapy to have a good recovery.
Massage Therapy can be very effective as an adjunct to fibromyalgia treatment. Patients who suffer mild symptoms may benefit even more from massage therapy but I would still add personal stretching to this. Heat is important as a therapy in itself. Many physicians are advocates for cold, where as I am a strong advocate for heat. Moist and dry heat can both be very helpful. Trial and error will be necessary for most to find which works best for you and it may vary ,time to time and area to area. This of course, is true of all the therapies.
Exercise is important to keep up in some way. I know this can be very difficult or near impossible for the severe fibromyalgics. I often suggest walking, swimming or biking in limited amounts. Remember to stretch before, sometimes during and of course, after exercise. You will find stretching after exercise will be easier and more effective.
Drugs! Doctors have an excellent knowledge of the pros and cons of medication and supplemental/herbal therapy. I should add that supplements and herbs are not the same thing. Supplements are medications that supplement what you already have in your body. Herbs are sometimes supplementing what you already have but are more often new chemicals that are foreign to your body like prescription medication. All can be very helpful but should be considered to be medications with potential side effects. The mainstay of any doctor for the treatment of fibromyalgia includes non-steroidal anti-inflammatories such as Voltaren, or the new kids on the block such as Celebrex and Vioxx (recently withdrawn from the market). These medications can be very helpful. They may not work well initially but may work as the spinal muscles are returned to their normal length. Muscle relaxants can be helpful but can be addictive. Examples include Robaxacet and Flexeril. Some of the older anti-depressants can be amazing for pain and sleep disorders. Amitrptyline, Nortriptyline and Trazadone are very effective for increasing the ability for sleep and decreasing the pain.
Remember good sleep can help break the triangle of chronic pain, sleep disorder and depression. "Brain fog" may also improve. Tryptophan and Immovane are often used for poor sleep but may be less effective. B-Blockers such as Inderal can be very effective for calming a person and reducing much of the upper body pain of fibromyalgia. Inderal, however, is contraindicated in asthmatics and possibly depressed individuals. Supplements can be very helpful. There are so many of them and the science behind them is huge, so I will only list a few. There are the old standbys of Glucosamine Sulfate, Chondroitin, Devil and Cat's Claw and Sharks Cartilage. Most of these products are aimed at cartilage supplementation and reducing inflammation. I have found them all to be helpful in some way but greatly successful for a reserved few.
Nevertheless, I often recommend them, as most people do not chew on pieces of cartilage in their diet and thus may benefit from supplementation. MSM has been recently introduced but has not been shown to be the cure-all that was promised.
Hormones. I often suggest different forms of hormone supplementation for some of my older patients with chronic pain. These hormones include testosterone for men and estrogen and progesterone for women. There will be a limited benefit for pain but some people will respond better than expected.
Growth Hormone will be a major player for pain and rehabilitation in the future. Growth Hormone is very much a "repair hormone", and will allow for pain sufferers to heal faster, and resist injury better. Be careful though, there is a downside, all hormone therapy may be associated with increased risk of cancer.
Other supplements include Melatonin, a central brain hormone that can dramatically help sleep and pain in some. It also stimulates growth hormone secretion but is not completely proven to be safe. L-Arginine is one of many amino acids that stimulates growth hormone naturally and may become a major player for pain and rehabilitation.
Creatine and Pyruvate are muscle supplements that enhance aerobic metabolism. This has the effect of allowing muscles to tolerate more injury with less shortening, i.e. less MFP. Be careful though, creatine may damage your kidneys. Calcium-B-hydroxy-B-methylbutyrate monohydrate, also known as HMB is an amazing muscle supplement that prevents muscle shortening and injury and therefore can help MFP , joint pain and performance enhancement for sports. CMO-cis-9 is an unusual fatty acid ester that is not found in humans but is found in some white mice. These specific white mice do not seem to suffer from arthritis. I have postulated that CMO-cis-9 probably acts to remyelinate (repair) damaged nerves of the spine and limbs that contribute to arthritic neuropathy.
Finally anti-oxidants may be of some benefit, as they help to reduce the damaging free-radicals that are moving through our bodies at all times. Everyday examples include Vitamins A, C and E but some stronger ones include grape seed extract and French Maritime Pine Bark. Of course, it is not a great idea to combine all these medications at once.
There is no one definite solution for fibromyalgia for all people. However, most fibromyalgics will respond gradually to a combination of physical therapy, medication and meditation. So yes, there is a cure for most patients suffering from fibromyalgia! Some people can not be totally cured but may be helped by a combination of therapy and analgesics.
Most sufferers can be reversed with a consistent but modifiable therapy consisting of stretching, physiotherapy, chiropractic, advanced needle therapy (IMS), supplemental medications, anti-inflammatories, pain killers, sleep enhancement therapy and stress reduction techniques.
All of my patients that were cured of fibromyalgia had one common thread-they all actively took part in their own recovery. I insist upon it because recovery is very difficult without the patient's deep participation and education.
You must find a physician who can guide you through the therapies and "can roll with the punches", as there is usually a wild ride up and down the road to recovery- but recovery is possible for most!
Also remember that some patients have a combination of myofascial pain with other conditions such as rheumatoid disease, cancer, radiation injury, depression, or even drug side effects. These conditions can greatly aggravate recovery and may make it impossible to fully recover unless they too are addressed.
Finally, please remember that I, and other physicians or therapists are not gods but are simply people trying to make a difference in a person's life that is truly suffering.
But there is hope!
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